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Pulmonary toxicity associated with antineoplastic therapy: Cytotoxic agents

Fabien Maldonado, MD
Andrew H Limper, MD
Section Editor
Kevin R Flaherty, MD, MS
Deputy Editors
Diane MF Savarese, MD
Helen Hollingsworth, MD


Adverse drug reactions (ADRs) due to antineoplastic agents are a common form of iatrogenic injury, and the lungs are a frequent target, as they process the entire cardiac output [1-3]. While some antineoplastic agent-induced ADRs are potentially preventable (particularly those that are related to cumulative dosing), many are idiosyncratic and unpredictable.

This topic review will provide an overview of the incidence and specific patterns of lung toxicity seen with cytotoxic chemotherapy agents. Separate monographs are available for many of the drugs that are most commonly associated with pulmonary toxicity. (See "Bleomycin-induced lung injury" and "Busulfan-induced pulmonary injury" and "Chlorambucil-induced pulmonary injury" and "Cyclophosphamide pulmonary toxicity" and "Methotrexate-induced lung injury" and "Mitomycin-C pulmonary toxicity" and "Nitrosourea-induced pulmonary injury" and "Taxane-induced pulmonary toxicity".)

A general discussion of the clinical presentation, pathogenesis, diagnosis, differential diagnosis, and management of antineoplastic agent-induced pulmonary toxicity is covered elsewhere, as is lung toxicity associated with molecularly targeted agents. (See "Pulmonary toxicity associated with systemic antineoplastic therapy: Clinical presentation, diagnosis, and treatment" and "Pulmonary toxicity associated with antineoplastic therapy: Molecularly targeted agents".)


(See "Bleomycin-induced lung injury".)


Bortezomib — Bortezomib is a reversible proteasome inhibitor that is used for the treatment of multiple myeloma (MM) and mantle cell lymphoma. In clinical trials, approximately 5 percent of patients report severe (grade 3 or worse) dyspnea, although the specific causality of bortezomib and the role of contributing factors such as anemia, respiratory infection, and cardiac dysfunction are unclear [4]. Cases of severe interstitial lung disease (some fatal) have been reported, mainly from Japan [5-7]. In addition, a few cases of pulmonary hypertension have been reported in the absence of left heart failure or significant pulmonary parenchymal disease [4,8]. The specific incidences of lung toxicity and pulmonary hypertension are unknown.

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Literature review current through: Nov 2017. | This topic last updated: Apr 18, 2017.
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